Larynx Cancer

Overview

Larynx cancer is a kind of throat cancer that affects the larynx. Cancer develops when certain cells proliferate uncontrollably. The cells penetrate and destroy the body as they multiply. These carcinogenic (malignant) cells begin in the larynx in laryngeal cancer (voice box).

Larynx carcinoma is a kind of head and neck cancer. Larynx cancer affects around 13,000 people in the United States each year. Every year, around 3,700 people are killed by it.

Early larynx cancer may not have any symptoms at all. Small growths of the vocal cords may produce hoarseness or coughing, making glottic cancer more likely to be diagnosed early. Early cancer of the supraglottis (above the vocal cords) may produce discomfort, which may be exacerbated by swallowing, and the pain may appear to include the ear, a condition known as referred ear pain.

What is the Larynx?

The larynx is located in your throat. It is sometimes referred to as the voice box. The larynx assists humans in speaking, breathing, and swallowing. The larynx contains our voice cords.

The larynx is mostly composed of cartilage, a flexible tissue that serves as a supporting framework. The larynx is divided into three sections:

1. Supraglottis (upper part): More than one in three laryngeal cancers (35%) start here.
2. Glottis (middle part): More than half of laryngeal cancers (60%) start here, where the vocal cords are.
3. Subglottis (lower part): About 5% of larynx cancers — 1 in 20 — start here.

What Does the Larynx Do?

The larynx assists us:

• Breathe: The voice chords open to allow air to enter.
• Speak: The vocal chords collapse. The vocal cords vibrate when air travels through them, assisting in the production of spoken sounds.
• Swallow: The epiglottis (a component of the supraglottis) descends across the larynx. To keep food out of the lungs, the voice chords shut.

Causes & Risk Factors for Larynx Cancer

Smoking or using other tobacco products raises your chance of acquiring larynx cancer significantly. Drinking alcohol, especially in large quantities, increases your risk. Using alcohol and smoke combined raises the danger even further.

Other risk factors for larynx cancer include:

• Age: Larynx cancer happens more in people age 55 and older.
• Gender: Men are more likely to develop this cancer, possibly because smoking and heavy alcohol consumption happen more among men.
• History of head and neck cancer: About one in four (25%) people who have had head and neck cancer will get it again.
• Job: People who have exposure to certain substances at work are at higher risk. These substances include sulfuric acid mist, wood dust, nickel, asbestos or manufacturing mustard gas. People who work with machines are also at higher risk.

Larynx Cancer Signs & Symptoms

It is common to confuse symptoms of larynx cancer with those of other diseases. If you have any of the following symptoms, see your doctor for an appropriate diagnosis:

• A persistent sore throat or cough.
• Hoarseness, for example, that does not improve after two weeks.
• When you swallow, you may have pain or other complications.
• A lump in the throat or neck causing neck pain.
• Dysphonia is the inability to produce vocal sounds.
• Ear ache.

If you have any of the following symptoms, get medical treatment immediately:

• Breathing difficulties (dyspnea).
• Stridor is characterized by loud and high-pitched breathing.
• Globus sensation, the sense that something is stuck in your throat.
• Spitting up blood (hemoptysis).

Diagnosis of Larynx Cancer

The following tests and procedures may be used:

1. Physical examination of the throat and neck: An examination to look for abnormalities in the throat and neck. The doctor will feel the inside of the mouth with a gloved finger and check the mouth and throat using a tiny long-handled mirror and light. The insides of the cheeks and lips, the gums, the back, roof, and floor of the mouth, the top, bottom, and sides of the tongue, and the neck will all be examined. Swollen lymph nodes in the neck will be felt. A history of the patient's health habits, as well as previous diseases and medical treatments, will be collected.
   
   
2. Biopsy: The removal of cells or tissues so that a pathologist may examine them under a microscope for signs of malignancy. The tissue sample may be extracted using one of the following techniques:
   • Laryngoscopy: A process in which a doctor examines the larynx (voice box) with a mirror or a laryngoscope for abnormalities. A laryngoscope is a tiny, tube-like tool with a light and a lens that allows you to see into your throat and voice box. It may also include an instrument for extracting tissue samples, which are then examined under a microscope for symptoms of malignancy.
   • Endoscopy: A procedure that examines organs and tissues within the body, such as the throat, esophagus, and trachea, for abnormalities. An endoscope (a narrow, lighted tube with a light and a viewing lens) is inserted into a body entrance, such as the mouth. Tissue samples may be removed using a specific instrument on the endoscope.
     
     
3. CT scan (CAT scan): A method that produces a series of detailed images of locations inside the body from various angles. A computer coupled to an x-ray machine creates the images. To make the organs or tissues more visible, a dye may be injected into a vein or ingested. This is also known as computed tomography, computerized tomography, or computerized axial tomography.
   
   
4. MRI (magnetic resonance imaging): A process that takes a series of detailed photographs of locations within the body using a magnet, radio waves, and a computer. This method is also known as nuclear magnetic resonance imaging (NMRI).
   
   
5. PET scan (positron emission tomography scan): A technique for detecting malignant tumor cells in the body. In a vein, a little quantity of radioactive glucose (sugar) is injected. The PET scanner revolves around the body, capturing images of where glucose is utilized. Because malignant tumor cells are more active and take up more glucose than normal cells, they appear brighter in the image.
   
   
6. PET-CT scan: A process that combines images from positron emission tomography (PET) with computed tomography (CT). The PET and CT scans are performed on the same equipment at the same time. The combined scans provide more comprehensive images of locations inside the body than either scan alone. A PET-CT scan may be used to aid in the diagnosis of disease, such as cancer, in the planning of treatment, or in determining how well treatment is working.
   
   
7. Bone scan: It is a test that determines if the bone contains fast dividing cells, such as cancer cells. A very small quantity of radioactive material is injected into a vein and passes through the circulation. The radioactive substance accumulates in the bones of cancer patients and is identified by a scanner.
   
   
8. Barium swallow: It is a sequence of x-rays of the esophagus and stomach. The patient consumes a barium-containing beverage (a silver-white metallic compound). The liquid covers the esophagus and stomach, and x-rays are obtained. This operation is also known as an upper GI series.

What are the Stages of Larynx Cancer?

1. Stage 0 (Carcinoma in Situ)

In stage 0, aberrant cells are discovered in the larynx lining. These aberrant cells have the potential to develop into cancer and spread to surrounding normal tissue. Cancer in situ is another term for stage 0.

2. Stage I

Cancer has established in the supraglottis, glottis, or subglottis of the larynx at stage I:

• Supraglottis: Cancer in one part of the supraglottis, yet the voice cords function correctly.
• Glottis: Cancer in one or both voice cords, although the vocal cords function correctly.
• Subglottis: Cancer only occurs in the subglottis.
  
  

3. Stage II

Cancer has established in the supraglottis, glottis, or subglottis of the larynx in stage II:

• Supraglottis: Cancer has advanced to the base of the tongue or tissues around the vocal cords or has spread to more than one location of the supraglottis. The voice cords function normally.
• Glottis: Cancer has progressed to the supraglottis, subglottis, or both, and/or the vocal cords are dysfunctional.
• Subglottis: Cancer has spread to one or both voice cords, causing the vocal cords to malfunction.
  
  

4. Stage III

In stage III, cancer has formed in the supraglottis, glottis, or subglottis area of the larynx:

In stage III cancer of the supraglottis:

• Cancer has progressed to the larynx and the voice cords are no longer functional, and/or cancer has spread to or through the inner section of the thyroid cartilage. Cancer may have spread to one lymph node on the same side of the neck as the initial tumor if it is 3 millimeters or smaller.
• The malignancy is in one part of the supraglottis, but the vocal cords are functioning appropriately. Cancer has spread to one lymph node on the same side of the neck as the initial tumor, which is 3 cm or less in size.
• Cancer has advanced to the base of the tongue or tissues around the vocal cords, or it has migrated to more than one location of the supraglottis. The voice cords function normally. Cancer has also progressed to one lymph node on the same side of the neck as the initial tumor, which is 3 cm or smaller in size.
  

In stage III cancer of the glottis:

• Cancer is in one or both vocal cords and the vocal cords work normally. Cancer has spread to one lymph node on the same side of the neck as the initial tumor, which is 3 cm or less in size.
• Cancer has progressed to the supraglottis, subglottis, or both, and/or the vocal cords are dysfunctional. Cancer has also progressed to one lymph node on the same side of the neck as the initial tumor, which is 3 cm or smaller in size.

In stage III cancer of the subglottis:

• Cancer has spread to the larynx and the vocal cords are no longer functional, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have spread to one lymph node on the same side of the neck as the primary tumor if it is 3 centimeters or smaller.
• Cancer is in the subglottis only. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller.
• Cancer has spread to one or both vocal cords, and they may no longer function correctly. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor, which is 3 centimeters or smaller in size.

5. Stage IV

Stage IV is broken into three stages: IVA, IVB, and IVC. Each substage of cancer in the supraglottis, glottis, or subglottis is the same.

In stage IVA:

• Cancer has spread to tissues other than the larynx, such as the neck, trachea, thyroid, or esophagus, via the thyroid cartilage. Cancer may have spread to one lymph node on the same side of the neck as the initial tumor if it is 3 millimeters or smaller; or
• Cancer from the supraglottis, glottis, or subglottis may have progressed to tissues other than the larynx, such as the neck, trachea, thyroid, or esophagus.

In stage IVB:

• Cancer may have spread from the supraglottis, glottis, or subglottis to the space in front of the spine, the area around the carotid artery, or the area between the lungs. The vocal cords may not work normally. 
  
  

Treatment Options for Larynx Cancer

There are different types of treatment for patients with larynx cancer.

Five types of standard treatment are used:

• Radiation therapy
• Surgery
• Chemotherapy
• Immunotherapy
• Targeted therapy
  
  

1. Radiation therapy

Radiation therapy is a cancer treatment that employs high-energy x-rays or other forms of radiation to either kill or prevent cancer cells from developing. External radiation therapy is the use of a machine located outside the body to direct radiation toward the cancerous location.

Radiation therapy may be more effective in people who have quit smoking before to starting treatment. External radiation treatment to the thyroid or pituitary gland may alter the thyroid gland's function. 

Larynx carcinoma may be treated with hyperfractionated radiation treatment. Hyperfractionated radiation therapy is a type of radiation treatment in which a lower-than-usual total daily dosage of radiation is split into two doses and administered twice day. Hyperfractionated radiation therapy is administered over the same time frame (days or weeks) as conventional radiation therapy. In the treatment of larynx cancer, new forms of radiation therapy are being explored.

2. Surgery

Surgery (surgical removal of the malignancy) is a typical therapy for all stages of larynx cancer. The following surgical techniques are possible:

• Cordectomy: A procedure that solely removes the voice cords.
• Supraglottic laryngectomy: Surgery to remove only the supraglottis.
• Hemilaryngectomy: Surgery to remove half of the larynx (voice box). The voice is saved through a hemilaryngectomy.
• Partial laryngectomy: Surgery to remove a portion of the larynx (voice box). A partial laryngectomy preserves the patient's capacity to communicate.
• Total laryngectomy: It is the surgical removal of the whole larynx. A hole is cut in the front of the neck during this procedure to allow the patient to breathe. This is known as a tracheostomy.
• Thyroidectomy: The removal of the entire or a portion of the thyroid gland.
• Laser surgery: A surgical treatment in which a laser beam (a narrow beam of bright light) is used as a knife to produce bloodless incisions in tissue or to remove a surface lesion such as a larynx tumor.

After the doctor removes all visible cancer during the operation, some patients may be given chemotherapy or radiation therapy to destroy any remaining cancer cells. Adjuvant therapy is treatment provided after surgery to reduce the probability of the cancer returning.

3. Chemotherapy

Chemotherapy is a cancer treatment that employs medications to halt the development of cancer cells, either by killing the cells or preventing them from growing. Chemotherapy medications enter the circulation and can reach cancer cells throughout the body whether administered orally or injected into a vein or muscle (systemic chemotherapy).

4. Immunotherapy

Immunotherapy is a cancer treatment that employs the patient's immune system to combat the disease. Substances produced by the body or created in a laboratory are used to augment, enhance, or restore the body's natural anti-cancer defenses. This cancer treatment is classified as a biologic therapy.

PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. Nivolumab and pembrolizumab are types of PD-1 inhibitors used to treat metastatic or recurrent larynx cancer.

5. Targeted therapy

Targeted therapy is a kind of cancer treatment in which medicines or other substances are used to locate and destroy specific cancer cells. Targeted treatments are less likely to kill normal cells than chemotherapy or radiation therapy.

Monoclonal antibodies are immune system proteins created in the laboratory to treat a variety of disorders, including cancer. As a cancer therapy, these antibodies can bind to a specific target on cancer cells or other cells, which may aid in the growth of cancer cells.

The antibodies can then attack the cancer cells, stop their development, or prevent their spread. Infusions of monoclonal antibodies are used. They can be employed alone or in combination to deliver medications, poisons, or radioactive material directly to cancer cells. Cetuximab is being researched as a therapy for larynx cancer.

What Happens After Larynx Cancer Treatment?

Following your treatment, you will have follow-up meetings with your healthcare practitioner to ensure that you are recuperating properly. Your service provider will:

• Any pain should be treated.
• Assist you in dealing with swallowing issues or mucositis (ulcers in the digestive tract).
• Discuss your diet to ensure that you are eating and swallowing properly.
• Physical therapy may be recommended if you have scars in your neck or difficulty opening your mouth.

Conclusion

Larynx carcinoma affects the larynx and is a kind of throat cancer. The larynx is your vocal cords. It has cartilage and muscles that let you to speak.

This form of malignancy can cause vocal cord injury. It may spread to other regions of your body if not treated promptly.

The first step in diagnosing larynx carcinoma is to review your medical history. If you have suspected cancer symptoms, your doctor will carefully examine you and conduct a battery of testing.

A laryngoscopy is generally the first test conducted. To check your larynx, your doctor will use a tiny scope or a series of mirrors.

In the early phases of treatment, your doctor may employ radiation therapy or surgery. Tumor removal surgery is a regular procedure.

Then, radiation therapy is used to try to eliminate any remaining cancer cells. To treat tiny malignancies, your doctor may recommend radiation treatment alone.

Your doctor may advise you to try anything other than surgery as an initial therapy. This generally occurs when a tumor is small enough that surgery is not required. It may also occur if surgery is performed too late to be totally successful. In any case, the aim is to maintain your quality of life.

Surgery, radiation, and chemotherapy are frequently used to treat advanced stages of larynx cancer.